Serum preadipocyte factor-1 concentrations in females with obesity and type 2 diabetes mellitus: the influence of very low calorie diet, acute hyperinsulinemia, and fenofibrate treatment.

Appropriate differentiation capacity of adipose tissue significantly affects its ability to store lipids and to protect nonadipose tissues against lipid spillover and development of insulin resistance. Preadipocyte factor-1 (Pref-1) is an important negative regulator of preadipocyte differentiation. The aim of our study was to explore the changes in circulating Pref-1 concentrations in female subjects with obesity (OB) (n=19), females with obesity and type 2 diabetes mellitus (T2DM) (n=22), and sex- and age-matched healthy control subjects (C) (n=22), and to study its modulation by very low calorie diet (VLCD), acute hyperinsulinemia during isoglycemic-hyperinsulinemic clamp, and 3 months' treatment with PPAR-α agonist fenofibrate. At baseline, serum Pref-1 concentrations were significantly higher in patients with T2DM compared to control group, while only nonsignificant trend towards higher levels was observed in OB group. 3 weeks of VLCD decreased Pref-1 levels in both OB and T2DM group, whereas 3 months of fenofibrate treatment had no significant effect. Hyperinsulinemia during the clamp significantly suppressed Pref-1 levels in both C and T2DM subjects and this suppression was unaffected by fenofibrate treatment. In a combined population of all groups, circulating Pref-1 levels correlated positively with insulin, leptin and glucose levels and HOMA (homeostasis model assessment) index. We conclude that elevated Pref-1 concentrations in T2DM subjects may contribute to impaired adipose tissue differentiation capacity associated with insulin resistance in obese patients with T2DM. The decrease of Pref-1 levels after VLCD may be involved in the improvement of metabolic status and the amelioration of insulin resistance in T2DM patients.

Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with Type 2 diabetes.

AIMS: The aim of this study was to compare the effects of calorie-restricted vegetarian and conventional diabetic diets alone and in combination with exercise on insulin resistance, visceral fat and oxidative stress markers in subjects with Type 2 diabetes. METHODS: A 24-week, randomized, open, parallel design was used. Seventy-four patients with Type 2 diabetes were randomly assigned to either the experimental group (n = 37), which received a vegetarian diet, or the control group (n = 37), which received a conventional diabetic diet. Both diets were isocaloric, calorie restricted (-500 kcal/day). All meals during the study were provided. The second 12 weeks of the diet were combined with aerobic exercise. Participants were examined at baseline, 12 weeks and 24 weeks. Primary outcomes were: insulin sensitivity measured by hyperinsulinaemic isoglycaemic clamp; volume of visceral and subcutaneous fat measured by magnetic resonance imaging; and oxidative stress measured by thiobarbituric acid reactive substances. Analyses were by intention to treat. RESULTS: Forty-three per cent of participants in the experimental group and 5% of participants in the control group reduced diabetes medication (P < 0.001). Body weight decreased more in the experimental group than in the control group [-6.2 kg (95% CI -6.6 to -5.3) vs. -3.2 kg (95% CI -3.7 to -2.5); interaction group × time P = 0.001]. An increase in insulin sensitivity was significantly greater in the experimental group than in the control group [30% (95% CI 24.5-39) vs. 20% (95% CI 14-25), P = 0.04]. A reduction in both visceral and subcutaneous fat was greater in the experimental group than in the control group (P = 0.007 and P = 0.02, respectively). Plasma adiponectin increased (P = 0.02) and leptin decreased (P = 0.02) in the experimental group, with no change in the control group. Vitamin C, superoxide dismutase and reduced glutathione increased in the experimental group (P = 0.002, P < 0.001 and P = 0.02, respectively). Differences between groups were greater after the addition of exercise training. Changes in insulin sensitivity and enzymatic oxidative stress markers correlated with changes in visceral fat. CONCLUSIONS: A calorie-restricted vegetarian diet had greater capacity to improve insulin sensitivity compared with a conventional diabetic diet over 24 weeks. The greater loss of visceral fat and improvements in plasma concentrations of adipokines and oxidative stress markers with this diet may be responsible for the reduction of insulin resistance. The addition of exercise training further augmented the improved outcomes with the vegetarian diet.

Plasma concentrations of fibroblast growth factors 21 and 19 in patients with Cushing's syndrome.

The objective of this study was to measure plasma fibroblast growth factor 21 and 19 (FGF21 and FGF19) levels in patients with Cushing's syndrome (CS) and to compare it with those of lean control subjects (C) and patients with obesity (OB). Fourteen untreated patients with CS, 19 patients with OB and 36 controls were included in the study. Plasma FGF21 and FGF19 levels were measured by ELISA kits, other hormonal and biochemical parameters were measured by standard laboratory methods. Plasma FGF19 did not significantly differ among the studied groups. Plasma FGF21 levels were significantly higher in both CS and OB groups relative to C group but they did not differ between CS and OB groups. In a combined population of all three groups FGF21 levels positively correlated with BMI, waist circumference and percentage of total and truncal fat mass. Less prominent inverse relationship with these parameters was found for FGF19. Neither FGF21 nor FGF19 were significantly related to cortisol concentrations. Increased FGF21 concentrations in both patients with CS and OB relative to lean subjects suggest that excessive body fat and/or related metabolic abnormalities rather than direct effects of cortisol are responsible. In contrast neither obesity nor hypercortisolism significantly affected FGF19 concentrations.

The influence of obesity and different fat depots on adipose tissue gene expression and protein levels of cell adhesion molecules.

Increased circulating adhesion molecules in patients with obesity play an important role in the development of endothelial dysfunction/atherosclerosis. The aim of this study was to assess the contribution of various fat depots to the production of adhesion molecules in obesity. 12 women with first and second degree of obesity, 13 women with third degree of obesity and 14 lean age-matched women were included into study. Circulating levels of vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and E-selectin were measured by Luminex kits. mRNA expression of ICAM-1, VCAM-1, E-selectin, monocyte chemoattractant protein-1 (MCP-1), and CD68 in subcutaneous (SAT) and visceral adipose tissue (VAT) was measured by RT-PCR; ICAM-1 and VCAM-1 protein levels by Luminex kits, normalized to protein content. Obesity increased ICAM-1 and VCAM-1 mRNA expression and protein levels and CD68 mRNA expression in VAT. Expression of E-selectin and MCP-1 did not significantly differ between groups. Expression of ICAM-1 and VCAM-1 positively correlated with expression of CD68 in both adipose depots. In VAT, ICAM-1 and VCAM-1 expression and protein levels positively correlated with BMI. Obesity was associated with increased adhesion molecules mRNA expression and protein levels in VAT, but not in SAT. Increased adhesion molecules production in visceral fat may provide a novel direct link between visceral adiposity and increased risk of cardiovascular complications.

[Physical activity in the treatment of obesity]. / Fyzictká aktivita v lécbe obezity.

Physical activity is a pivotal component in the treatment of obesity. An increase in energy expenditure through physical activity in combination with a weight reduction diet intensifies negative energy balance, brings a reduction in fat reserves and, simultaneously, prevents loss of an active body mass. The main aim and significance of physical activity in obese individuals is not the weight reduction itself but its positive effects on factors that represent an increased cardiovascular risk. When prescribing a physical activity to an obese individual, selection of a suitable form, intensity, duration and frequency of load should all be considered. Patient cooperation represents an essential factor in the success of a therapy involving physical activity and is concurrently affected by the presence of other obesity complicating diseases. Also important are other negative factors determined by real life: lack of time, lack of support from family and others, bad weather, inaccessibility of suitable equipment or space or aversion to physical activity as such. When these circumstances are overcome, positively motivating reasoning has to be provided. Communication between physicians and non-medical professional community is the only way to influence physical activity of obese patients and minimise adverse effects. Significant increase in physical activity of the entire population is determined by modifications in physical and social environment and revision of healthcare policy.

[The incidence of obesity and its complications in the Czech Republic]. / Výskyt obezity a jejích komplikací v Ceské republice.

Over the recent years, the incidence of obesity is continuously rising. A research conducted in 2008-2009 on a representative sample of Czech population (n = 2,058) suggests that 23% of adult population of the Czech Republic are obese and 34% are overweight. This represents an increase of 5% in the number of obese people (17% vs. 22%), while the number of overweight remains practically the same (35% vs. 34%). A more significant shift in female waist circumference compared to male has also been shown. The incidence of hypertension in the evaluated sample was more than a two-fold higher in obese participants (48% vs. 21%) and as much as 3-fold higher in type 2 diabetes mellitus (7% vs. 20%). The risk of body weight increase is the highest between 50th and 59th year of age, where hypertension and diabetes are the most frequently diagnosed. The risk of obesity in adulthood is mostly carried over from childhood and more than 3/4 (77%) of those, who were overweight or obese as children, are in these categories as adults. Quality of life and satisfaction with own health is more related to BMI than age. Even though body weigh is increasing with the same amplitude in sportsman and physically active people, they are reaching lower final BMI due to their lower starting body weight. It is clear that physically active lifestyle in younger age is the best predictor of lower BMI in adult life. Consumption of secondary processed meat and lower consumption of fruit and vegetables are important factors in adulthood.

[The influence of 6-months treatment with exenatide on type 2 diabetes mellitus compensation, anthropometric and biochemical parameters]. / Vliv 6mesícního podávání exenatidu na kompenzaci diabetes mellitus 2. typu, antropometrické a biochemické parametry.

OBJECTIVES: Exenatide, a synthetic GLP-1 analogue, is a new antidiabetic agent from the group ofincretine mimetics coming into the daily clinical practice. In our study we evaluated the effect of 6-months treatment with exenatide on diabetes compensation, anthropometric and biochemical parameters in the patients with poorly controlled type 2 diabetes mellitus and obesity. METHOD: We included 18 patients with poorly controlled diabetes (mean HbA1c 8.5 +/- 0.3%) treated with diet and peroral antidiabetic agents (4 patients were treated with insulin in the past). Exenatide was administered via subcutaneous injection twice daily for 6 months. Patients were examined after 1 month, when the dose ofexenatide was increased from 5 microg twice daily to 10 microg twice daily and after 3 and 6 months. We evaluated the diabetes compensation, biochemical parameters, body weight changes and side effects ofexenatide. RESULTS: 6-months exenatide treatment significant decreased body weight (baseline vs 6 month treatment 107.3 +/- 4.4 kg vs 103.7 +/- 4.6 kg, p = 0.02), BMI (36.7 +/- 1.2 kg/m2 vs 35.3 +/- 1.3 kg/m2, p = 0.01) a HbA1c (8.5 +/- 0.3% vs 7.4 +/- 0.4%, p = 0.04) and increased HDL-cholesterol (0.92 +/- 0.1 mmol/l vs 0.98 +/- 0.1 mmol/l, p = 0.02). Fasting glycemia tended to decline at the end of the study, but the difference did not reach the statistical significance. The area under the curve of glycemia levels after the standardized breakfast in the subgroup of 8 patients after the 6-months exenatide treatment was significantly lower when compared to baseline values (2,908 +/- 148 vs 2,093 +/- 194, p = 0.03). Concentrations of total and LDL-cholesterol and triglycerides did not change significantly. The most frequent side effects of exenatide treatments were transient anorexia and nausea (38.5%), dyspepsia and functional gastrointestinal discomfort (38.5%) and various neuropsychical symptoms (nervosity and insomnia - 30.8%). Most of the side effects disappeared during the treatment, none of these side effects was a reason for discontinuation of a treatment. 3 minor hypoglycemic episodes occured in patients simultaneously treated with derivates of sulfonylurea, but no serious hypoglycemia occured during the entire study. CONCLUSION: Exenatide treatment in obese patients with poor diabetes control was accompanied by statistically significant decrease of body weight, improvement of diabetes control and increase in HDL-cholesterol.

Serum concentrations and tissue expression of a novel endocrine regulator fibroblast growth factor-21 in patients with type 2 diabetes and obesity.

OBJECTIVE: Fibroblast growth factor-21 (FGF21) is a novel endocrine and paracrine regulator of metabolic homeostasis. The aim of our study was to measure its serum concentrations in patients with obesity, obesity and type 2 diabetes mellitus (T2DM) and healthy subjects (C), and to assess the changes of its circulating levels and mRNA expression after dietary and pharmacological interventions. DESIGN: We measured biochemical parameters, serum FGF21, adiponectin, leptin and insulin levels by commercial ELISA and RIA kits, and mRNA expression in the liver, subcutaneous and visceral fat by RT PCR in 26 obese patients, 11 T2DM patients and 32 control subjects. The interventions were acute hyperinsulinaemia during isoglycaemic-hyperinsulinaemic clamp, very low calorie diet (VLCD) and 3 months treatment with PPAR-alpha agonist fenofibrate. RESULTS: Baseline serum FGF21 levels were significantly higher in both obese and T2DM patients relative to healthy controls. FGF21 levels in obesity did not significantly differ from T2DM group. Both 3 weeks of VLCD and 3 months of fenofibrate treatment significantly increased FGF21 levels. FGF21 mRNA expression in visceral fat was twofold higher in obesity relative to C group, while it did not differ in subcutaneous fat. VLCD significantly increased FGF21 mRNA expression in subcutaneous fat of obesity. 3-h hyperinsulinaemia during the clamp increased FGF21 levels in T2DM but not in C group. CONCLUSION: An increase in FGF21 levels after VLCD and fenofibrate treatment may contribute to positive metabolic effect of these interventions and suggests the possibility of direct positive metabolic effects of FGF21 in humans.

[Comparison of various methods of body fat analysis in overweight and obese women]. / Srovnání ruzných meted pro stanovení mnozství tuku v tele u zen s nadváhou a obezitou.

INTRODUCTION: Body composition assessment and determination of the amount and distribution of body fat, respectively, form an essential part of the basic clinical assessment of an obese patient. However, there are no recommended methods to determine the amount of fat in obese population. The aim of our study was to compare the methods most frequently used to determine the amount of body fat in overweight and obese women in clinical practice (multi-frequency bio-electrical impedance analysis--BIA using the Bodystat, Omron and Tanita machines and the skinfold test using a calliper) with a reference method (DEXA). The study further aimed to compile prediction formulae enabling clinicians to calculate the percentage of body fat when using the available body fat measurement techniques. METHODS: The study included 61 overweight and obese women (mean age 48.6 years +/- 13.9 years). Four practice-based body fat assessment methods were used - bioimpedance technique with tetra-polar electrode arrangement (Bodystat machine), bioimpedance technique with bi-pedal electrode arrangement (Tanita machine), hand-held bioimpedance technique (Omron machine) and the anthropometry assessment--the skinfold calliper technique. These methods were compared to the method considered as the reference--the whole body densinometry (DEXA). RESULTS: The results obtained using the listed body fat assessment methods suggest that the resulting body fat measurements differ importantly depending on the method used. The highest correlation with DEXA was found for the Bodystat BIA (r = 0.9096, p < 0.001). Prediction formulae were constructed for a more accurate calculation of body fat content when using the techniques evaluated in the present study. CONCLUSION: When the newly compiled formulae are employed, the body fat assessment obtained with any of the methods applied in the present study will approximate DEXA. The BIA techniques were found to be particularly precise. Therefore, further evaluation of these techniques is recommendable to support their use as methods for monitoring the efficacy of weight reduction programmes in overweight and obese patients.

Comparisin of low energy breakfast based on special egg white spread product with a standard breakfast.

AIM: The aim of the study was to evaluate the influence of a new form of low calorie breakfast in comparison to standard low fat cheese breakfast. A special spread based on egg white was used (Energy content per 100 g: 319 kJ versus 802 kJ, fat content 1.15 g versus 15 g). Egg white derived products are widely used for weight reduction in Czech Republic. METHODS: 12 non-diabetic patients were included into the study (7 men and 5 women), mean age 38.5+/-10.7 years, and mean BMI 24.6 kg/m2. Standard breakfast was served first in a time interval of 1 week (Krajanka cheese) and after a week wash-out period low energy breakfast based on egg white was served for the same time. Glucose level, insulinaemia and C peptide were evaluated in 0, 60, 120 minute after breakfast. Psychological questionnaire was used to evaluate the taste and satiety. RESULTS: Standard breakfast: insulinaemia 6.3...34.6...11.0 IU, C peptide 0.6...1.6...1.0 pmol/l, glucose 5.0...5.4...4.8 mmol/I Low energy breakfast: insulinaemia 6.6...24.6...10.7 IU, C peptide 0.6...1.4...1.0 pmol/I, glucose 4.8...5.1...5.0 mmol/l. Paired t-test was used for evaluation. No difference in blood glucose level was found, borderline significances of insulinaemia in 60 minute (p= 0.056) and in C peptide (p= 0.089). Significant difference in decrease of insulinaemia between 60 and 120 minute (p=0.03) and borderline significant decrease in C peptide (p=0.055) shows shorter insulin secretion after low calorie breakfast and good insulin sensitivity in this group of lean subjects. Higher satiety and less-worthier taste were found using low energy breakfast. CONCLUSION: Low calorie breakfast induces lower and shorter insulin secretion and has a good metabolic effect in lean subjects. Testing in obese subjects will follow. Egg white derived low calorie products have a beneficial effect on insulin response without any difference in ingested carbohydrate quantity.

[The influence of very-low-calorie diet on soluble adhesion molecules and their gene expression in adipose tissue of obese women]. / Vliv nízkokalorické diety na sérové koncentrace a expresi cytoadhezivních molekul v tukové tkáni u obézních zen.

BACKGROUND: Adhesion molecules (AM) are proteins expressed on the endothelial surface that play an important role in development of endothelial dysfunction. Higher concentrations of AM were found in patients with atherosclerosis, obesity or type 2 diabetes mellitus. The aim of our study was to measure serum concentrations and gene expression of ICAM-1 (intercellular adhesion molecule 1), VCAM-1 (vascular adhesion molecule 1) and E-selectin in subcutaneous adipose tissue samples obtained by needle biopsy from obese women and healthy controls and to evaluate the effect of 3-weeks very-low-calorie diet (VLCD) on these parameters. METHODS AND RESULTS: 20 obese women (BMI 46.2 +/- 9.7 kg/m2) and 13 lean control women (BMI 23.8 +/- 2.3 kg/m2) were included into the study. Gene expression of AM in subcutaneous adipose tissue was measured using RT-PCR, serum AM levels were measured by multiplex immunoanalysis. At the baseline, serum E-selectin concentrations were higher in obese women compared to controls (24.4 +/- 2.3 vs. 15 +/- 1,5 ng/ml, p < 0,05). 3 weeks of VLCD significantly decreased BMI and serum E-selectin levels. Baseline mRNA expression of E-selectin, ICAM-1 and VCAM-1 in subcutaneous adipose tissue was lower in obese relative to lean women (p < 0.05). Weight reduction increased ICAM-1 and VCAM-1 gene expression (p < 0.05). CONCLUSIONS: Our results suggest that the subcutaneous adipose tissue is not the major source of the studied soluble adhesion molecules in obese women and that the regulation of AM local gene expression in subcutaneous adipose tissue probably differs from its circulating levels.

The effect of adrenalectomy on exercise response of the renin-angiotensin-aldosterone system and exercise tolerance in primary aldosteronism.

Primary aldosteronism (PA) is associated with objectively measured lower physical fitness and blunted response of the renin-angiotensin-aldosterone system to exercise. The purpose of this pilot study was to objectively measure exercise response of the renin-angiotensin-aldosterone system and cardiopulmonary fitness changes after laparoscopic adrenalectomy (ADE) in patients with unilateral PA. We examined a total of 14 patients with confirmed PA before and after ADE, by means of spiroergometry and hormonal evaluation. As expected, after adrenalectomy basal aldosterone (Aldo) levels before exercise decreased significantly, with a concomitant increase in plasma renin (PR). The increase in Aldo (285.9+/-171.3 to 434.1+/-278.2 ng/l; p=0.02) and blunted increase in PR (7.1+/-0.4 to 8.9+/-10.4 pg/ml; NS) post-exercise before ADE became significant after ADE Aldo post-ADE (46.8+/-18.8 to 106.5+/-68.1 ng/l; p<0.0001) and PR post-ADE (20.1+/-14.5 to 33.9+/-30.7 pg/ml; p=0.014). After adrenalectomy, the patients had a non-significant increase in peak workload and VO(2peak). We found normalization of the renin-angiotensin-aldosterone system response to exercise with little changes in cardiopulmonary fitness six months after ADE.

Comparison of lipid lowering effect of sibutramine in patients treated or not treated with statins--3 month follow-up.

Older sibutramine studies showed beneficial effects on lipid profile compared to placebo. However, nowadays many obese patients are treated with lipid lowering drugs before the start of sibutramine therapy and their effects in these patients have not been investigated. Therefore we started a long-term follow up of patients on sibutramine with or without previous and continuing statins. Here we present results of the first 3 months follow up of 11 patients on sibutramine 10 mg +statin group, and that of 13 patients on sibutramine 10 mg alone. Sibutramine led to the weight loss from 101.6 to 96.9 kg and in BMI from 36.35 to 34.66 kg/m2. Lipid profile changed thus: total cholesterol 4.97...5.01mmol/l (p = 0.7), LDL cholesterol 2.83...2.82 mmol/l mmol/l (p = 0.9), HDL cholesterol 1.13...1.27 mmol/l (p = 0.003), triglycerides 1.98...1.91 mmol/l (p = 0.01). Comparison between the 2 groups did not show any significant differences in lipid levels, patients react to sibutramine in the same way regardless to the concomitant statin therapy. We can therefore preliminarily conclude that sibutramine therapy has significant positive effect on the lipid profile even in patients who were started on statins prior to initiation of sibutramine treatment.

[Defining the level of physical activity for a diabetic who is obese]. / Stanovení intenzity fyzické aktivity u obézních diabetiku.

Physical activity plays an important role in the treatment of metabolic syndrome and/or type 2 diabetes or obesity. Less than 20% of the adult population does physical exercise at least twice a week. The effectiveness of physical exercise depends on paying attention to the following parameters: the frequency, the intensity and the duration. The most difficult parameter to set for patients with obesity or metabolic syndrome is the optimum intensity of exercise. The most common means of measuring the intensity of physical activity is heart rate or pulse rate. With patients who take medicines that affect their heart rate, the Borg scale is used to give a subjective rating of perceived exertion. To set optimal intensity it is necessary to use exertion tests with these patients. The most accurate setting is a suitable combination of spiroergometry and a CHR (clamped heart rate) test. In practice, though, it is usually enough to combine ergometry together with the Borg scale. Tracking exertion parameters during exercise improves patient compliance and also the results of exercise.

[Physical activity centre VSTJ MEDICINA Prague--rehabilitation for diabetics]. / Rekondicní centrum VSTJ MEDICINA Praha--rekondice diabetika.

Physical activity is the basic non-pharmacological instrument in the treatment of type 2 diabetes. Nevertheless, only a small number of diabetics take regular physical exercise. One of the reasons why diabetics "do not exercise" is that they have little opportunity to try physical stress under expert supervision and to get to know its effects on, for example, sugar levels. It is a very complex matter to define the optimal intensity of physical activity of, for example, a diabetic who suffers from obesity. In 2001 VSTJ MEDICINA Prague opened its first physical activity centre at the First Faculty of Medicine, Charles University in Prague, in cooperation with the Third Internal Clinic and the Institute of Sports Medicine of the First Faculty of Medicine, Charles University in Prague. It now has over 2000 members, of whom around 60% are patients with metabolic syndrome. Over 150 patients exercise every day under the supervision of expert instructors. The main objective of the Physical Activity Centre is to teach patients the correct principles of physical exercise to enable them to continue carrying out their trainers' instructions at home. A correct understanding of the importance of physical exercise and practical experience under the supervision of experienced instructors improves compliance and has a strong effect on the compensation of diabetes, thereby improving the prognoses of these patients.

[Regular aerobic physical activity improves the lipid profile in persons with excessive body weight]. / Pravidelná aerobní pohybová aktivita zlepsuje lipidový profil u osob s vyssí nez normální telesnou hmotností.

UNLABELLED: A review of physical activity-induced lipid changes is presented. The review was compared with results we obtained in a reconditioning program involving 25 untrained obese patients who attended the reconditioning centre of the 1st Faculty of Medicine of Charles University for three months. A significant decrease was found in both HDL-cholesterol, triglycerides and the atherosclerosis index. No significant changes were recorded in the total and LDL-cholesterol level. CONCLUSION: Aerobic physical activity can induce changes in lipid levels in overweight and obese patients. Indication of regular aerobic physical activity should not be omitted in current practice.

[The influence of obesity on the gene expression of adiponectin and its receptor in subcutaneous adipose tissue]. / Vliv obezity na genovou expresi adiponektinu a jeho receptoru v subkutánní tukové tkáni.

UNLABELLED: The objective of the study was to measure the concentration of adiponectin in plasma, its mRNA expression and the expression of the adiponectin receptors AdipoR1 and AdipoR2 in subcutaneous adpipose tissue (ST) of women with various levels of fat in their organism. A further objective of the study was to determine to what extent the stated parameters correlate with obesity as defined by BMI (body mass index) and how it can be affected by a very low calorie diet (VLCD). PATIENT SAMPLE: The sample of 70 women was divided into groups by BMI: patients with class 3 obesity (BMI > 40 kg.m(-2), n = 25), patients with class 1 and 2 obesity (BMI 30-40 kg.m(-2), n = 15), overweight patients (BMI 25-30 kg.m(-2), n = 10) and a normal healthy control group (BMI 20-25 kg.m(-2), n = 20). In the case of 14 women with class 3 obesity, the parameters were measured before and after a three-week diet with an energy content of 2200 kJ (550 kcal)/day (VLCD). METHOD: Plasma concentrations of adiponectin were measured using an ELISA kit (LINCO Research, USA). Subcutaneous adipose tissue was taken using biopsy. RNA was isolated using a MagNA Pure Compact RNA Isolation Kit (Tissue) (Roche, SRN). The gene expression of adiponectin, AdipoR1 and AdipoR2 was determined using the real-time PCR (RT-PCR) method on a ABI Real-Time PCR 7500 instrument (Applied Biosystems, USA) with TaqMan Gene Expression Assays hydrolisation probes. beta-2-mikroglobulin (beta2M) was used as an endogenous control, to which the data was normalised. RESULTS: The circulatory concentration of adiponectin, its mRNA expression and the mRNA expression of AdipoR1 in ST correlate negatively with BMI (r = -0.524, p < 0.001; r = -0.460, p < 0 001; p = -0.354, p = 0.004). The expression of AdipoR2 in ST did not correlate with BMI. The VLCD reduced weight by 9% but did not affect the plasma concentration of adiponectin or the rate of its expression, or the expression of AdipoR1 and AdipoR2. CONCLUSION: Our results show that not only the circulatory concentration of adiponectin but also its mRNA expression and the expression of AdipoR1 in ST are significantly lower in obese women compared to a control group and may contribute to the development of metabolic complications in obesity.

Lower physical fitness in patients with primary aldosteronism is linked to the severity of hypertension and kalemia.

Hypokalemia as a typical feature of primary aldosteronism (PA) is associated with muscle weakness and could contribute to lower cardiopulmonary fitness. The aim of this study was to describe cardiopulmonary fitness and exercise blood pressure and their determinants during a symptom-limited exercise stress test in patients with PA. We performed a cross-sectional study of patients with confirmed PA who were included before adrenal vein sampling on whom a symptom-limited exercise stress test with expired gas analysis was performed. Patients were switched to the treatment with doxazosin and verapamil at least two weeks before the study. In 27 patients (17 male) the VO(2peak) was 25.4+/-6.0 ml/kg/min which corresponds to 80.8+/-18.9 % of Czech national norm. Linear regression analysis shows that VO(2peak) depends on doxazosin dose (DX) (p=0.001) and kalemia (p=0.02): VO(2peak) = 4.2 - 1.0 * DX + 7.6 * Kalemia. Patients with higher doxazosin doses had a longer history of hypertension and had used more antihypertensives before examination, thus indicating that VO(2peak) also depends on the severity of hypertension. In patients with PA, lower cardiopulmonary fitness depends inversely on the severity of hypertension and on lower plasma potassium level.

The influence of n-3 polyunsaturated fatty acids and very low calorie diet during a short-term weight reducing regimen on weight loss and serum fatty acid composition in severely obese women.

Polyunsaturated fatty acids of n-3 series (n-3 PUFA) were shown to increase basal fat oxidation in humans. The aim of the study was to compare the effect of n-3 PUFA added to a very low calorie diet (VLCD), with VLCD only during three-week inpatient weight reduction. Twenty severely obese women were randomly assigned to VLCD with n-3 PUFA or with placebo. Fatty acids in serum lipid fractions were quantified by gas chromatography. Differences between the groups were determined using ANOVA. Higher weight (7.55+/-1.77 vs. 6.07+/-2.16 kg, NS), BMI (2.82+/-0.62 vs. 2.22+/-0.74, p<0.05) and hip circumference losses (4.8+/-1.81 vs. 2.5+/-2.51 cm, p<0.05) were found in the n-3 group as compared to the control group. Significantly higher increase in beta-hydroxybutyrate was found in the n-3 group showing higher ketogenesis and possible higher fatty acid oxidation. The increase in beta-hydroxybutyrate significantly correlated with the increase in serum phospholipid arachidonic acid (20:4n-6; r = 0.91, p<0.001). In the n-3 group significantly higher increase was found in n-3 PUFA (eicosapentaenoic acid, 20:5n-3, docosahexaenoic acid, 22:6n-3) in triglycerides and phospholipids. The significant decrease of palmitoleic acid (16:1n-7) and vaccenic acid (18:1n-7) in triglycerides probably reflected lower lipogenesis. A significant negative correlation between BMI change and phospholipid docosahexaenoic acid change was found (r = -0.595, p<0.008). The results suggest that long chain n-3 PUFA enhance weight loss in obese females treated by VLCD. Docosahexaenoate (22:6n-3) seems to be the active component.

Influence of metabolic state and diabetes on the outcome at the end of first year after gastric banding.

BACKGROUND: The influence of metabolic state and the presence of diabetes before surgery on the weight changes following non-adjustable gastric banding, were studied. METHODS: The total of 50 patients referred for gastric banding had the following parameters measured: insulinemia, glycemia, total cholesterol, triglycerides (TAG), dehydroepiandrostendione (DHEA) and its sulphate (DHEA-S), triiodothyronine, thyroxine, and thyroxine-stimulating hormone. We evaluated 28 of these, who completed at least 6 months of follow-up. 12 of these patients had diet-treated non-insulin dependent diabetes mellitus (NIDDM) and 16 were non-diabetics, and 9 of them had a positive family history of NIDDM (FH DM). We compared the change in weight of the diabetics, non-diabetics and those with positive FH DM, at 3, 6 and 12 months after the operation. Multiple linear regression tested the influence of the measured parameters on patients' weight. RESULTS: Weight loss was greatest in the group of patients without a positive family history of diabetes, and lowest in the diabetic group. Due to the high dispersion, differences in the t-test are not significant. When individual factors and their influence on weight development were tested by multiple linear regression, weight loss was greatest in patients with high TAG and low insulin levels and lowest in patients with diabetes or positive FH DM. CONCLUSIONS: Although post-operative weight can be influenced by other factors, eg. psychological ones, it is advisable to test each patient pre-operatively for insulin and TAG levels, and to establish family history of diabetes and presence of diabetes to give an idea of the prognosis of weight change.